<%--
  Created by IntelliJ IDEA.
  User: 64619
  Date: 2019/6/20
  Time: 14:38
  To change this template use File | Settings | File Templates.
--%>
<%@ page contentType="text/html;charset=UTF-8" language="java" %>
<html>
  <head>
    <title>申诉单</title>
  </head>
  <script>

  </script>
  <style>

  </style>
  <body>
  <div align="center">
    <form >
    <table border="1">
      <tr align="center">
        <th colspan="5" rules="none">申诉单</th>
      </tr>
      <tr>
        <td rowspan="2" width="210px" align="center">申诉人</td>
        <td width="220px">姓名(必须为申诉所涉及号码机主姓名)</td>
        <td width="300px"><input type="text" name="" ><a color="red">*</a> </td>
        <td width="210px">联系电话</td>
        <td width="300px"><input type="text" name="" >* </td>
      </tr>
      <tr>
        <td>电子邮件</td>
        <td><input type="text" name="">* </td>
        <td>邮箱编码</td>
        <td><input type="text" name="">* </td>
      </tr>
      <tr>
        <td rowspan="2" align="center">被申诉人</td>
        <td>企业名称</td>
        <td colspan="3">
          <select>
            <option value="福州市">福州市</option>
            <option value="厦门市">厦门市</option>
          </select>
          <select>
            <option value="鼓楼">鼓楼</option>
            <option value="台江">台江</option>
          </select>
          <select>
            <option value="电信">电信</option>
            <option value="移动">移动</option>
          </select>
        </td>
      </tr>
      <tr>
        <td>通信地址</td>
        <td colspan="3"><input type="text" name="adress"> </td>
      </tr>
      <tr>
        <td align="center">是否就申诉事项向被申诉人提出投诉</td>
        <td colspan="4">
          <input type="radio" name="yes">是
          <input type="radio" name="no">否
        </td>
      </tr>
      <tr>
        <td align="center">被申诉人是否给予处理或答复</td>
        <td colspan="4">
          <input type="radio" name="yes">是
          <input type="radio" name="no">否
        </td>
      </tr>
      <tr>
        <td rowspan="3" align="center">申诉内容</td>
        <td>申诉要求</td>
        <td colspan="3">
          <textarea  rows="3" cols="115" style="resize:none; Overflow:Hidden; Overflow-y:scroll;" placeholder="详见附件用户申诉信" ></textarea>
        </td>
      </tr>
      <tr>
        <td>申诉事实与理由</td>
        <td colspan="3">
          <textarea  rows="3" cols="115" style="resize:none; Overflow:Hidden; Overflow-y:scroll;"  placeholder="详见附件用户申诉信"></textarea>
        </td>
      </tr>
      <tr>
        <td>申诉要求</td>
        <td colspan="3">
          <textarea rows="3" cols="115" style="resize:none; Overflow:Hidden; Overflow-y:scroll;" rows="3" placeholder="详见附件用户申诉信"></textarea>
        </td>
      </tr>
      <tr>
        <td>申诉来源</td>
        <td colspan="4">
          <select>
            <option value="传真">传真</option>
            <option value="复印">复印</option>
          </select>
        </td>
      </tr>
      <tr>
        <td>附件上传</td>
        <td colspan="4">
          <input type="text">
          <input type="button" value="浏览...">
          <input type="button" value="添加附件">
        </td>
      </tr>
      <tr>
        <td colspan="5" height="100px">
          <div align="center">
            <input type="button" value="提交">
          </div>
        </td>
      </tr>
    </table>
    </form>
  </div>
  </body>
</html>
